The Digital Advantage

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The digitalisation of a hospital or clinic is a multi-dimensional challenge. For the technology to pro-actively support the organisational procedures, streamline the information flows and help to arrange management and clinical processes, it is not enough to buy and implement an IT system.

The successful implementation of an electronic medical record system requires a completely new philosophy in terms of operation and innovative thinking. This is my list of 24 ideas to help integrate a healthcare IT solution into the organisational structure, while generating added value for patients and personnel.

Employ / nominate the CIOs: a doctor and a nurse to be responsible for IT
Digitalisation requires leaders that understand IT-related subjects and have an interest in innovative technologies, while also being active IT system users who are familiar with its strengths and weaknesses. The organisation of work processes differs between doctors and nurses. This means that involved and passionate leaders should be appointed from each group – a leading doctor for IT and a leading nurse for IT. They will be notified of the needs, problems and ideas to be discussed at the next stage during the regular meetings with the manager. New positions are a way of bringing medical personnel closer to digitalisation issues.

Define a vision, strategy and measurable targets
A document that describes the vision and long-term objectives should form the basis for each decision to invest in IT systems. It should include information on the objectives of the facility (e.g. EHR-implementation, patient service quality and personnel satisfaction improvement, and cost reductions) with a definition of the time horizon. The objectives should be defined as numbers and percentages, to enable ongoing verification of progress towards their achievement.

Plan the budget
One of the greatest investment errors is the lack of pre-reserved funds for digitalisation. Purchasing an IT system is not a one-time cost – it requires that the strategic plans include the necessary system updates, upgrades, equipment maintenance, additional training, functional expansions and personnel hiring. One way is to reserve a specific percentage of the budget for IT purposes, which helps to avoid regular conflicts of interest with other, more important investments (which are not uncommon). When the budget is limited, funds should be sought from external resources or a public-private partnership.

Check IT resources and process an integration audit
This is important not just for those facilities implementing a complex system, but also for units already using an integrated solution. How can we convert the information we collect and exchange into an electronic form? Can we integrate information from various areas? What kind of information, apart from obligatory information, do we need to include in electronic patient records to achieve the objectives? What data do we need to make clinical decisions, for smooth management and for patient service? What information does the manager need for smooth facility management? Each medical facility should review its IT resources on a regular basis to sustain the development of the current system and to increase the digitalisation rate of the processes.

Strengthen the IT department
Organisational efficiency is all about the people, meaning that personnel management must consider the IT department employees. Purchase press subscriptions (also international) on e-health issues, attend specialist training, conferences and fairs, purchase books, and make reference visits to other facilities. The digitalisation of healthcare is so dynamic that we need to keep pace. New knowledge should inspire and initiate ideas for the IT development of the facility.

Monitor the registered data quality
Even the most advanced system will fail to deliver material benefits if we fail to ensure the scope, accuracy and correctness of the data being entered. The informative value is significantly reduced by incomplete input, using custom descriptions instead of prepared dictionaries, spelling errors, limiting doctor’s appointment information to the minimum required (diagnosis, service), and other mistakes. The IT department should systematically analyse information quality and initiate personnel training to resolve the issues.

Maintain the partnership with the IT solution supplier
One of the mistakes made during the software purchase process is to adopt a transactional approach instead of developing our partnership with our supplier. IT is not a product, but primarily a service to be performed and developed throughout its life, both today and in 10 years’ time. Having regular meetings with the supplier’s representative after they implement the system keeps us up to date with innovations and helps us to plan any expansion of resources. It is better if we communicate this in advance, at the purchasing stage.

Learn how to use digital health benchmarking
It is better, or at least cheaper, to learn from the mistakes of others rather than from our own. The IT solution supplier should have a list of reference implementations available. It’s worth to establish a know-how partnership with the best-digitalised  hospitals or clinics. There is nothing wrong in looking for good practices, which is easier with an overview of market information concerning new implementations and projects, as well as reading professional reports on computerisation procedures.

Use innovative public procurement
In innovative public procurement the priority is not the price, but the added value of the solution. This does not exclude the achieving of a good price, but it certainly increases the probability of obtaining the projected benefits. The procurement process should, for example, allow us to enter into dialogue with the suppliers, to define our needs and to find the optimum solution together. This also means that a medical facility with specific expectations does not have to purchase a finished, standard IT system.

Create an innovation culture
A culture of innovation is always initiated by the manager. Unless phrases like “modernity”, “digital competencies”, “patient service quality”, “e-health” become priorities, the potential of the software will not be employed in practice. The potential functionality of the systems offered by the market leaders remain largely unused in most facilities, because using the potential of IT resources depends on the management and having a modernity-oriented organisational culture. This is an approach worth passing on to the personnel.

Communicate the achievement of IT objectives
The personnel should be part of the software implementation strategy for unit operations. Training is not everything. During the meetings with employees, it is necessary to communicate the achievement of the digitalization objectives as well as the further plans, along with analysing and discussing all difficulties and current successes. This helps to avoid the situation where the personnel consider the system to be a waste of money and a single problem (e.g. lengthened data input) determines the general evaluation of the system. Communicating IT objectives is also about listening to the personnel and modifying the inconveniences related to the use of the software. Also at this point it is necessary to consider a strategic instead of a technical approach to digitalization.

Launch multi-disciplinary innovation teams
How can we improve appointment planning or use of reasonably available technical resources? How can we improve communication with the patient? How to improve the  quality of care? Organisational improvements can be implemented by launching system functions. Ideas coming from the lowest rank of employees often lead to multi-million savings, so they are worth noting during the meetings and in the surveys. Giving managers the sole ability to make decisions is a detachment from the realities of facility operation.

Close the distance between patient and IT
Patients often complain that doctors hide behind their computer displays, while doctors complain that they cannot talk to patients in any other way because they are obliged to enter the required information into the electronic records. Technology does not increase this distance, but poor working procedures do. According to communication experts, it is enough to set the computer display so that the patient can see the data being entered during the appointment. In turn, up to date patient notifications about the procedures in the system strengthens the feeling of professionalism. Such transparency also increases patient trust and understanding.

Co-ordinate patient care
The patient stay path in a medical facility and in particular wards (hospital, outpatient department, rehabilitation, catering etc.) should be integrated as part of a well-designed information exchange process in the IT system. The doctor will see the prescribed examination results, the procedures performed by the nurse and the medicines prescribed by other specialists, and thus be able to prescribe a suitable diet and provide key information to the specialist taking over the patient care. A smooth information flow leads to improvements in the standards of care.

Offer IT benefits to the patient
One of the most important objectives of the IT system implementation is to improve the patient service quality. We should not forget about this, while we focus on administration procedures, the development of electronic medical records or paying agent billings. A pro-patient operating strategy can strengthen selected system functions: medicine interaction checker, dosing recommendation print-outs, online registration, appointment reminders, notifications on prevention and health promotion activities, periodic examinations, waiting room queue shortening system, etc.

Surprise through innovations
Be open for new tools: mobile applications for doctors to aid completing electronic medical records, applications for patients with e-registration and automatic notification of patient presence at the facility (“beacons”), a patient portal with signing-up to the EHR and personalised movies and recommendations, applications and tools for remote consultations. These technologies offer a range of innovations that can be successfully (and inexpensively) offered to the patients and the personnel.

Develop co-operation with science, business, startups
New research operations, additional funds, and interesting initiatives – we need to do no more than look around to see opportunities for partnership and co-operation in the projects that the medical facility cannot complete on its own (due to limited funds, development base or know-how).

Share the knowledge
With time, the IT system becomes a source of knowledge about the local epidemiological situation and health trends. Based on anonymous data, a facility can prepare cross-sectional analyses, using them to plan for the future, including prevention and health-promotion programmes. What is known as “small data” has significant information potential, which we can access through the analyses and statistics section available with every professional IT system. Of course, this relates to data without patient information (anonymous).

Don’t forget forecasting and planning
The data on registration, admissions by particular doctors, appointment hours, services and issued prescription medicines help to define target groups for the medical facility and to manage them (e.g. suitable personnel numbers at rush hours, registration organisation). Every manager should define the type of necessary reports and how often they are prepared. With results and essential summaries being presented during the meetings attended by the personnel and management, the operation of the entity becomes more transparent and correspond more closely to the actual processes.

Implement workflow patterns
The necessity of moving between tabs and entering data without any chronological order makes the work of the medical personnel significantly more difficult. The system should organise the work, arrange the order and force the data type for entry into the system. This is a way to define the operating procedures that support information quality and facilitate daily, routine operations, especially for the medical personnel. Tip: before the system defines the operating mode, the sequence of activities should be thoroughly discussed with the personnel. Once established, the order will determine the manner of fulfilling duties, efficiency and, finally, employee satisfaction and patient service quality.

Personalise the software
Despite procedures and standardisation, most good IT systems allow a wide customisation margin. The visibility of tabs and particular data groups should depend on access rights, the availability of functions and even colours – since we work with the software every day the personal aspect is essential. More understanding of the IT department, even regarding impossible requests, is always welcome.

Prepare for remote healthcare
Although everyone is waiting for better e-consultation funding, it is high time to explore the subject and include it in our digitalisation strategies. This might not be a necessity now, but it will be in a few years’ time. To avoid surprises, the possibility of implementing remote healthcare modules or applications means it is necessary for the system to include technical requirement specification or, if an IT solution has already been implemented, to ask the manufacturer for an opinion and prepare for the project.

Concentrate on personalised healthcare
The greater the use of electronic health records, the wider the opportunities for implementing the principles of personalised healthcare, in which detailed patient records are essential for the adjustment of the doctor’s and medical facility’s activities to suit the patient’s needs. Personalised healthcare is not just about treatment, it also includes prevention. A transparent overview of information from laboratory test results, illnesses, medicines taken, and lifestyle (based on interviews) can help us to select a suitable health promotion programme. Personalised healthcare also translates into medicine interaction control, determination of treatment path in accordance with the patient’s situation, preferences or age group.

Involve the IT department in clinical processes
The IT personnel should achieve a detailed understanding of hospital operation, working procedures, daily patient service paths, and the organisational problems of doctors, nurses and administration personnel. The basic concept is to avoid the situation where the IT department is reduced to equipment maintenance, software configuration and troubleshooting. The purpose is to avoid misunderstandings between the IT personnel and medical personnel, hence bridging the communication and trust gap. The IT specialists are obliged to observe the daily work of the hospital, including attendance at meetings with doctors (understanding clinical processes), and nurses (exploring the patient service process). The idea is to organise regular consultations between, for example, the leading doctor for IT, the leading nurse for IT, IT specialists and management, seeking ways to resolve organisational bottlenecks.

Comment and join the discussion: What would you add to the list above?

 

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